Volume 211 Issue 7

Despite the evolving needs of patients and changing societal expectations, Australasian intensive care continues to provide a world leading service to patients and the broader society

Stephen Warrillow · Raymond Raper

The similarity in mortality among Indigenous and non-Indigenous critically ill patients hides a complex story

Paul J Secombe · Alex Brown · Michael J Bailey · David Pilcher

Achieving gender equity in intensive care medicine requires specific interventions to attract and retain female trainees and support their progress to leadership roles

Lucy J Modra · Sarah A Yong

Innovative design methodologies may improve the statistical efficiency and success of future randomised trials

Sandra Peake · Anthony Delaney · Craig J French

Why is some strong evidence ignored while some weak evidence is rapidly acted upon?

Benjamin Reddi · Mark Finnis · Sandra Peake

Understanding how to identify acid-base disorders is essential, as their consequences can be life-threatening

KJ Farley · Elisa Licari

We are not viewed or valued by our community through a lens of disease, machines and location

Neil R Orford

… but how are we deciding which patients are selected for ICU referral and admission?

Alison M Mudge

New health information technologies have the potential to transform the delivery of mental health care

Ian B Hickie

Routine screening of older ICU patients for frailty could improve outcome prediction and inform health care planning

Jai N Darvall · Rinaldo Bellomo · Eldho Paul · Ashwin Subramaniam · John D Santamaria · Sean M Bagshaw · Sumeet Rai · Ruth E Hubbard · David Pilcher

Increasing ICU size may have improved health care system efficiency

Peter Hicks · Sue Huckson · Emma Fenney · Isobel Leggett · David Pilcher · Edward Litton

The increasing age and obesity rates of the Australian population are contributing to the higher prevalence of patients with obstructive sleep apnoea presenting for surgery

Nicolette R Holt · Glenn Downey · Matthew T Naughton

Over two decades of Dutch experience can inform deliberations about the nature of a regulatory framework in Australian jurisdictions

Vicky Sheppeard · Robin Gilmour · Sean Tobin

To the Editor: Student‐run clinics (SRCs) empower students to employ logistics, operational management and clinical skills to provide free or affordable health care to underserved populations. SRCs have the dual benefits of student learning and care for underserved patients and promote health equity, interprofessionalism and student leadership.1,2 These clinics are well established in North America but are nascent in Australia. Some sections of the Australian population still face challenges accessing health care, including Aboriginal and Torres Strait Islander people, refugees and rural and homeless populations;3 SRCs not only meet this need but also assist with the growing demand for clinical placements for medical and allied health students.4 In 2012, the first Australian SRC began providing medical, nursing, social work and physiotherapy services in Melbourne,3 and similar clinics have also sprouted in New South Wales and Queensland.2,5 In the same vein, medical students from Flinders University in Adelaide piloted the Flinders Student Run Clinic (FSRC), with the support of faculty and of the Vinnie's Men's Crisis Centre, which provides crisis accommodation, meals, showers and case management for up to 47 homeless and vulnerable men aged over 18 years. From December 2016 to January 2017, student volunteers staffed weekend shifts providing consultations to residents. Clinic days were well subscribed, with about a dozen clients attending each session. Students were surveyed before and after volunteering on aspects of clinical training, preparedness and motivation. Out of 24 medical student volunteers, eight responded to the pre‐survey and six to the post‐survey. Before volunteering, students believed their clinical knowledge and skills would improve and they would be able to manage problems and unexpected events. After volunteering, students were less confident in their abilities and felt less valuable to the clinic, but were more prepared to work with vulnerable individuals, face morally challenging issues and achieve their goals. Volunteering also clarified students’ motivations and values, demystifying primary care with underserved populations, and they were motivated to be involved in similar programs in the future. Feeling less prepared may stem from exposure to responsibilities as primary health care staff on the ground. Further studies can explore expectation‐matching for different parties and the financial impact of similar programs. Furthermore, the use of SRCs in Australia to both teach and serve the community should be encouraged.

Andrew IH Phua · Yvonne K Parry

To the Editor: A 40‐year‐old man with no past medical history presented to the emergency department complaining of a painful red rash across his back, which he noticed when he undressed at home after work. On examination, the patient was systemically well with normal vital signs. He had a non‐blanching, band‐shaped erythematous rash across his upper back, with no associated vesicles, consistent with a first degree burn. The patient worked as a field environmental engineer and was required to wear high visibility shirts throughout his working day. It was noticed that the band‐shaped rash coincided with the upper high visibility band on his work shirt (Box). The patient also reported that the high visibility tape on his shirt often becomes extremely hot when he works out in the sun, and he occasionally has to change position so the shirt does not touch his skin in that area. The rash was managed as a first degree burn, with emollient aloe vera cream and simple analgesia. Retroreflective tape is used on work clothing to increase the wearer's visibility to others, especially in the dark. It usually consists of minute glass beads or prismatic elements encapsulated in a transparent film, which reflect light back towards its source. Safety warnings mention cases of increased heat build‐up around shoulders, neck and ears, but no cases have been published in the medical literature. Skin abrasions have also been described when aged tape cracked and frayed was brushed against the forehead.1 The manufacturers also warn about the tape risk to smoulder or melt when subjected to heat. To the authors' knowledge, this is the first reported case of skin burns occurring secondary to overheating of retroreflective tape. Even though not life‐threatening, it caused discomfort to the patient for a few days. Workplaces mandating clothes with retroreflective tape should ensure that garments with the tape in areas touching the skin are not worn in very hot and sunny conditions and consider using removable vests instead. Manufacturers should consider designing shirts that decrease direct contact between retroreflective tape and skin, potentially by increasing the number or thickness of cloth layers under it. Box – Band‐shaped erythematous rash across the patient's upper back coinciding with the upper retroreflective band on the work shirt

Ioana Vlad

Professor Jeffrey Lipman is a world leader in intensive care medicine, and he wouldn’t have it any other way

Cate Swannell

Med J Aust 2019; 211 (7 Suppl).